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21-year-old student from Yemen, blinded in bomb blast, regains vision in one eye after corneal transplant at Amrita Institute of Medical Sciences

Islam Hussein, a class 11 student who dreams of becoming a doctor, also lost both his hands in the explosion and has now been put on priority list for hand transplant

A 21-year-old patient from Yemen, Islam Hussein, who lost both his hands and eyesight in a bomb blast, has regained vision in one eye after successfully undergoing corneal transplant at Amrita Institute of Medical Sciences. The surgery, that involved complete reconstruction of the left eye, was conducted by a team of eye surgeons from the hospital led by Dr. Anil Radhakrishnan , Consultant, (Cornea & Refractive Surgery) and Dr. Gopal S. Pillai , Professor & HOD, Dept. of Ophthalmology.

Islam, the third of six children of a 45-year-old school teacher, hails from a village near Taiz, an ancient city among the steep cliffs of central Yemen. The birthplace of Yemen's Arab Spring in 2011, it is a war-torn region where firefights between rival militias are a daily occurrence and the landscape is littered with landmines and unexploded bombs.

In September 2017, Islam, a student of Class 11, was walking on a street near his home when he accidently stepped on a mine laid by the warring groups in the area. It exploded, severely injuring his hands and legs, disfiguring his face and mangling his eyes. He was rushed to a hospital, but lost vision in both the eyes.

Doctors said Islam’s legs had to be amputated, but his father refused to give up and moved him to a hospital in Egypt, where both his hands had to be amputated below the elbow due to infection. Doctors were not capable of helping him further, however. One of Islam’s friends recommended treatment in India, and the patient and his family arrived at the Amrita Institute of Medical Sciences in December 2017, after undergoing plastic surgery on his foot in Jaipur.

Due to medical reasons, the hand transplant team at Amrita felt that the hand transplant for Islam would be more feasible after he regained his vision. Said Dr. Anil Radhakrishnan, Consultant (Cornea & Refractive Surgery), Amrita Institute of Medical Sciences, Kochi: “Islam’s right eye was beyond recovery as the structure behind the lens was badly damaged and the eye had shrunk in size. We therefore focused on the left eye. We reconstructed the shattered eye structures and, conducted corneal transplant and reconstructed the eye. We were not sure if it would work, as there was a membrane in front of the retina. But it was joy all around when, a day later, Islam opened his eye and could clearly see his mother in front of him. It was a very emotional moment for everyone, and both Islam and her mother couldn’t hold back their tears. He has regained 90% of vision in his left eye and is seeing perfectly with the help of glasses. He has also begun to walk around without any assistance.”

Dr. Gopal S. Pillai, HOD, Dept. of Ophthalmology, Amrita Institute of Medical Sciences, Kochi, added: “When Islam came to Amrita hospital, his face, which used to be handsome before, was completely burnt and disfigured from the blast. The massive blunt injury damaged his eyes, as if hit by a hammer. We gave priority to repairing the eye and regaining visual function. Now that Islam can see with his eye, he wants to go for a hand transplant so that he can lead a normal life. We have put him on the priority list for hand transplants.”

Bombs going off are common in Islam’s village where 500-600 people have lost their limbs in the past three years in explosions. Said Islam: “I consider myself very lucky to be alive. I also thank God and the doctors of Amrita Hospital that I can see the world again with my own eyes. Family was my main source of strength and support during this difficult time. It is like a second birth for me, as I had given up all hope. I always had dreamt of becoming a computer engineer, but after seeing the medical miracles at Amrita Hospital, I want to become a doctor and help transform lives, like they have transformed mine.”

Islam’s mother, 40-year-old Dikhra Hussein, said that Islam was always very good at studies. “Our entire family had tears in eyes when Islam got his vision back and he could see us again. I want him to now continue his studies, become a doctor, and perhaps, return to India, the country which has given him so much love and care.”

Many patients of advanced Parkinson’s disease in Kerala now leading near-normal life after undergoing DBS procedure

Parkinson’s Disease Patient Support Group announced at Amrita Institute of Medical Sciences

A neuro-surgical procedure called Deep Brain Stimulation (DBS) offers patients of advanced Parkinson’s disease a new ray of hope, enabling them to lead near-normal life, neurology specialists at Amrita Institute of Medical Sciences said on the eve of World Parkinson’s Day. They also announced the formation of a Parkinson’s Disease Patient Support Group, which was formally inaugurated by Dr. Jayshree Ben Mehta, President, Medical Council of India.

Said Dr. Anand Kumar, Head, Dept. of Neurology, Amrita Institute of Medical Sciences: “The Parkinson’s Disease Patient Support Group is initially made up of about 500 patients of Parkinson’s from the Amrita Hospital, but any patient from anywhere in India is welcome to join. Patients will be provided support and counselling through WhatsApp groups.”

Addressing the media about the breakthrough DBS procedure, Dr. Ashok Pillai, Clinical Professor, Dept. of Neurosurgery, Amrita Hospital, said: “Deep Brain Stimulation surgery is now being offered in Kerala. It involves the implantation of a neuro-stimulator, often called 'brain pacemaker,’ in the patient’s body. It is connected to the head through wires which send electrical impulses to specific areas deep in the brain. DBS is a boon to patients with advanced Parkinson’s Disease with drug-induced problems or where drugs are failing. It offers patients much better control over the symptoms and an enhanced quality of life. In addition, robotic technology called ROSA can ensure very high precision during the implantation of the neuro-stimulator. It enables minimally invasive surgery of the central nervous system with a level of precision not possible by human hand.”

DBS is meant for Parkinson’s patients up to 70 years of age who do not respond well to treatment and are unable to manage their day-to-day activities because of their motor problems. They either have frequent ‘off’ periods when they are hardly able to make motor movements, or they have excess of unwanted movements which can be very troublesome and present upto 75% of the time that they are awake. Patients who have had at least five years of symptoms of Parkinson’s Disease are eligible for this procedure, which takes just four to five hours. Nowadays, robotic frameless surgeries are coming into vogue which are much more comfortable for patients.

Added Dr. R. Suresh Kumar, Professor, Dept. of Neurology, Amrita Hospital: “DBS is not a cure but it significantly improves quality of life of the patient. However, there are less than 20 centers in India which offer DBS implantation. In Kerala, only two or three hospitals offer a regular DBS program. This is not enough as about 33 to 41 patients per one lakh population suffer from Parkinson’s disease in the country. DBS is a costly treatment and there is a lack of awareness among patients about this procedure, which is an obstacle to its widespread adoption.”

DBS surgery involves two stages. The first is the “awake stage” in which the patient remains awake when the surgeon inserts the electrodes in the head, and a neurologist assists the surgeon in deciding the exact target based on a clinical examination of the patient. The second stage is done under general anesthesia and involves fixing the neuro-stimulator in a pocket made in the chest muscles and tunneling the wires through the neck tissue to the head.

Gold nasal stud removed from the lungs using a novel endoscopic technique

The Interventional Pulmonology Team at Amrita Hospital, Kochi successfully removed a gold nasal stud (Mookuthi) from the lungs of a 21-year-old lady from Palarivattom. The stud reached the lungs inadvertently while she was sneezing. Initially she thought she had swallowed it into her stomach. For confirmation a chest x-ray was taken from a nearby hospital, which showed aspirated gold stud in lowest part of her right lungs. Generally a keyhole surgery of lungs is done at many hospitals to retrieve any sharp objects which get trapped in lower part of lungs.

In order to avoid a surgery, the patient consulted Dr. Tinku Joseph, Interventional Pulmonologist at Amrita Hospital, Kochi. He performed an endoscopic procedure using a newly designed hooked forceps which was guided through the endoscope into the lower lobe of patient's lung were the gold stud was located. After 2.5 hours of effort he managed to successfully retrieve the gold stud from lungs, thereby saved her from the trauma and the high cost of undergoing a surgery.

“When there is a foreign body in the lung, the lungs gets destroyed. When the lung gets destroyed, there could be pus formation, pneumonia and over a period of time it could cause irreparable damage," said Dr. Tinku Joseph. “Among people who are suffering from asthma and allergy, there is a high risk of aspiration of nasal piercings and studs if they are not worn properly. Also such objects can lead to persistent nasal irritation and sneezing among people who are suffering from allergy,” he added.

Global Challenge PhD Studentship at University of Birmingham

Radiosurgery for Intracranial Indications : Update 2017

Radiosurgery for Intracranial Indications : Update 2017 was a one day CME and workshop aimed at divulging the underexplored scope of radiosurgery in the treatment of intracranial indications through evidence-based approach to provide insight for the young radiation oncologists, neurosurgeons, allied professionals and to the practicing consultants about the comprehensive approaches of robotic radiosurgery and neurosurgery for intracranial indications. It was the second academic programme of the year hosted on December 16, 2017 in connection with radio-surgery following the “AAHPRT”- CME & Liver SBRT Workshop on June and July 2017.

The CME also portrayed the protocol-based novel approaches developed and practiced in Robotic Radiosurgery at the Centre for High Precision Radiotherapy, Amrita Institute of Medical Sciences.

There was an overwhelming response from divergent group of professionals pan India and especially from Kerala. The event was jointly organised by the Department of Radiation Oncology and Neurosurgery, Amrita Institute of Medical Sciences in association with AROI (Association of Radiation Oncologists of India) - Kerala Chapter. This tri-point amalgamation marked a memorable union of experts and thus resulted in an unbounded knowledge exchange. Expert from different parts of India shared their experience with the young and budding aspirants wishing to take radiosurgery treatment as carrier option.